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Can antiretroviral therapy prevent HIV-associated cognitive disorders?

Winston, Alana , b; Vera, Jaime H.a , b

Current Opinion in HIV and AIDS: January 2014 - Volume 9 - Issue 1 - p 11–16
doi: 10.1097/COH.0000000000000016
DOES ANTIRETROVIRAL TREATMENT AT HIGH CD4 COUNTS REDUCE DISEASE RISK FOR HIV-POSITIVE PATIENTS?: Edited by Jason V. Baker and Caroline A. Sabin

Purpose of review In general, the initiation of combination antiretroviral (cART) is associated with improvement in cognitive function. However, the impact of cART has on cognitive function in neurologically asymptomatic HIV-infected individuals initiating therapy at high CD4+ lymphocyte cell counts is unknown.

Recent findings Cognitive function impairment remains prevalent despite effective cART. Several clinical risk factors for this condition have been described, including low nadir CD4+ lymphocyte cell count which may be associated with greater neuroinflammatory process, a potential pathogenic mechanism underlying this cognitive impairment. The earlier initiation of antiretroviral therapy could theoretically avoid this risk factor and limit the degree of neuroinflammation. On the converse, the earlier initiation of cART may be associated with the development of neuronal toxicities.

Summary This review article highlights the recent literature and arguments for and against the earlier initiation of cART with regards to cognitive function.

aFaculty of Medicine, Department of Medicine, Imperial College London, St Mary's Hospital Campus

bDepartment of HIV and Genitourinary Medicine, Imperial College Healthcare NHS Trust, London, UK

Correspondence to Dr Alan Winston, Clinical Reader and Consultant Physician, Clinical Trials, Ground Floor Winston-Churchill Wing, St. Mary's Hospital, Praed Street, London W2 1NY, UK. Tel: +44 203 312 1603; fax: +44 203 312 6123; e-mail: a.winston@imperial.ac.uk

© 2014 Lippincott Williams & Wilkins, Inc.